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Title: Characterization of inflammatory response in hepatorenal syndrome: Relationship with kidney outcome and survival.
Author: Solé Padullés, Cristina
Solà, Elsa
Huelin, Patricia
Carol, Marta
Moreira, Rebeca
Cereijo, Unai
Mas, José-Manuel
Graupera, Isabel
Pose, Elisa
Napoleone, Laura
de la Prada, Gloria
Juanola, Adrià
Fabrellas i Padrès, Núria
Torres, Ferran
Morales Ruiz, Manuel
Farrés, Judith
Jiménez Povedano, Wladimiro
Ginès i Gibert, Pere
Keywords: Cirrosi hepàtica
Síndrome hepatorenal
Hepatic cirrhosis
Hepatorenal syndrome
Issue Date: 29-Dec-2018
Publisher: John Wiley & Sons
Abstract: Background: Several lines of evidence indicate that decompensated cirrhosis is characterized by the presence of systemic inflammation. Hepatorenal syndrome (HRS-AKI) is a unique type of renal failure that occurs at late stages of cirrhosis. However, confirmation of the presence and significance of such inflammatory response in HRS-AKI is lacking. Aim and methods: To characterize the systemic inflammatory response, as estimated by measuring a large number of cytokines, in 161 patients hospitalized for an acute decompensation of cirrhosis: 44 patients without acute kidney injury (AKI), 63 patients with hypovolaemia-induced AKI and 58 patients with HRS-AKI. Results: HRS-AKI was characterized by an altered cytokine profile compared to the other two groups, particularly IL-6, IL-8, TNF-α, VCAM-1, fractalkine and MIP-1α. The inflammatory response was not related to presence of bacterial infection, concomitant acute-on-chronic liver failure or severity of renal dysfunction. Patients who responded to terlipressin and albumin had only a decrease in TNF-α and RANTES after treatment without changes in other cytokines. Interestingly, patients with persistent HRS-AKI had higher levels of IP-10 and VCAM-1 compared to those with resolution of HRS-AKI. VCAM-1 was also an independent predictor of 3-month mortality. A systems biology analysis approach showed that the inflammatory status of HRS-AKI was similar to that of chronic nonhepatic inflammatory conditions, such as lupus erythematosus or inflammatory bowel disease. Conclusion: Hepatorenal syndrome is characterized by a marked systemic inflammatory state, reminiscent of that of nonhepatic inflammatory diseases, that correlates with patient outcomes.
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It is part of: Liver International, 2018, vol. 39, num. 7, p. 1246-1255
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ISSN: 1478-3223
Appears in Collections:Articles publicats en revistes (Medicina)

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